Bianca Embry
Bessemer,AL
Summary
Results-oriented Medical Claims Processor skilled in communicating with providers to resolve claim issues. Demonstrated ability to juggle various administrative responsibilities while maintaining high standards. Investigative expertise contributes to thorough and precise claims management.
Overview
9
9
years of professional experience
1
1
Certification
Work History
PIP ADJUSTER
United Auto Insurance
04.2024 - Current
- Examined insurance claims to determine coverage and liability, ensuring fair settlements.
- Collaborated with clients to collect essential documentation for processing claims efficiently.
- Conducted investigations into incidents, assessing damages to support claim evaluations.
- Produced comprehensive reports detailing findings and suggestions for claim resolutions.
- Optimized claims review workflows, resulting in reduced processing times and increased efficiency.
- Nurtured relationships with policyholders by providing clear updates on claim statuses.
- Analyzed outcomes of claims to identify areas for policy improvement and risk management.
- Oversaw a varied caseload of personal injury protection claims with meticulous attention to detail.
PIP ADJSUTER
KEMPER INSURANCE
11.2019 - Current
- I monitor and pay claims for our insured's and qualified parties
- Qualify parties for coverage using Accurint, tracked their medical treatment, contact providers and attorneys in order to make sure we were maximizing our insured's benefits
- Assist SIU department with claims investigations, for files referred to their department and direct SIU's investigation in order to rule out any improper claim submission
- Assist with determining if Examinations under Oath were necessary as well as worked closely with House Counsel to determine if coverage was applicable under state and Department of Insurance rules
- Lead coverage investigation issues, including Material Misrepresentation and collaborate with other departments for resolution
- Communicates with police holders, clients, police, and necessary parties
- Performs thorough inspection of vehicles and created appropriate estimates
- Works closely with body shops and automobile professionals to discuss and negotiate repair pricing and assess liability
- Aims to provide clients with the highest level of customer service possible
- Creates and manages timely, clear and accurate documentation and work flow throughout.
PIP ADJUSTER
Pearl Holding Group
07.2023 - 04.2024
- Maintained strong relationships with policyholders, agents, and colleagues by consistently demonstrating professionalism, empathy, and effective communication skills.
- Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
- Assisted clients in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely.
- Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies.
- Collaborated with medical professionals to review injury claims, ensuring proper treatment plans were in place and accurately calculating compensation based on severity and long-term impact.
- Analyzed information gathered by investigations to report findings and recommendations.
- Reviewed various billing system reports to identify billing discrepancies.
- Processed customer billing invoices and payments daily for monthly billing cycle.
PIP ADJUSTER
Sentry Insurance
08.2022 - 06.2023
- Maintained strong relationships with policyholders, agents, and colleagues by consistently demonstrating professionalism, empathy, and effective communication skills.
- Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
- Assisted clients in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely.
- Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Contributed to team success by participating in regular training sessions, sharing best practices, and mentoring new adjusters.
- Streamlined workflow for faster claim resolution by coordinating with various internal departments and external agencies.
CLINICAL ASSISTANT
SEALE HARRIS CLINIC
03.2018 - 11.2019
- Comforted anxious patients before procedures and listened to concerns, offering support and compassion
- Coordinated with appropriate administrative staff to address clinical, operational and financial questions
- Gathered forms, copied insurance cards and [Action] to collect patient information for billing and insurance filing
- Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs
- Enhanced patient outcomes by providing knowledgeable education on procedures, medications and other physician instructions
- Interviewed patients about their complaints, gathered and interpreted medical reports.
REFERRAL COORDINATOR
ALABAMA PAIN PHYSICIANS
04.2016 - 04.2018
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process
- Weighed patient need, provider availability and insurance coverage to determine optimal scheduling
- Called insurance companies to get precertification and other benefits information on behalf of patients
- Provided ongoing counseling to help patients deal with conditions and processes coordinated program referrals for community-based resources
- Coordinated individualized discharge plans to manage safe transition back into community and home environments
- Preserved and prepared reports and treatment records
- Organized clinical documentation, treatment plans, and referrals
- Updated treatment plans on monthly basis with latest intervention strategies and progress notes.
Education
BACHELORS OF SCIENCE HEALTH EDUCATION -
UNIVERSITY OF ALABAMA AT BIRMINGHAM
12.2015
Skills
- Investigation expertise in insurance policies
- data collection and analysis proficiency
- digital research capabilities
- top-tier customer service skills
- guided quality care practices
- effective verbal and written communication
- efficient multi-tasking abilities
- general medical terminology knowledge
- effective problem-solving techniques
- general administrative support tasks
Certification
Currently licensed as a PIP adjuster in Florida. State of Florida Licensed PIP adjuster
Timeline
PIP ADJUSTER
United Auto Insurance
04.2024 - Current
PIP ADJUSTER
Pearl Holding Group
07.2023 - 04.2024
PIP ADJUSTER
Sentry Insurance
08.2022 - 06.2023
PIP ADJSUTER
KEMPER INSURANCE
11.2019 - Current
CLINICAL ASSISTANT
SEALE HARRIS CLINIC
03.2018 - 11.2019
REFERRAL COORDINATOR
ALABAMA PAIN PHYSICIANS
04.2016 - 04.2018
BACHELORS OF SCIENCE HEALTH EDUCATION -
UNIVERSITY OF ALABAMA AT BIRMINGHAM